The Continued Need for Immunizations in 2016 Stephanie Schauer, Ph.D. Program Manager, Immunization Program April 13, 2016 Ten Great Public Health Achievements United States, 1900-1999 MMWR 1999 Control of infectious diseases Vaccination Motor-vehicle safety Safer workplaces Decline in death from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as health hazard Wisconsin Department of Health Services 2 www.cdc.gov/mmwr/ Top Ten Causes of Death in the U.S., 1900 vs. 2010 Common Questions about Vaccines How do vaccines protect us? Are they effective? Why do we need to keep vaccinating? Are they safe? What vaccines are recommended? 3 http://all-that-is-interesting.com/top-10-causes-death-1900-2010 4 How do vaccines work? HOW DO VACCINES WORK? Vaccines use a person s immune system to protect against disease. A weakened form of the disease germ (the vaccine) is injected into the body. The immune system responds and makes specialized cells and antibodies to fight the germ. 5 6 1
How do vaccines work? The immune system keeps some of these cells and antibodies around long past vaccination. If the germ ever gets into the body, the immune system can rapidly call up these memory cells and respond to the germ quickly and more efficiently, inactivating it before it can cause disease. This memory persists for years, and often for life. ARE VACCINES EFFECTIVE? (AND IF SO, WHY DO WE NEED TO STILL VACCINATE?) 7 8 How successful have vaccines been? So why keep immunizing if the diseases are gone? While some diseases are becoming rare, it is because we are vaccinating against them. If we stop, then the diseases could start spreading again. Before long, we would see epidemics again as the number of individuals who are not protected rises. 9 http://www.cdc.gov/vaccines/pubs/pinkbook 10 Herd Immunity Are vaccines effective? No vaccine (or medicine) is 100% effective, but many provide excellent protection. Many give life-long protection (though some may need boosters to provide high levels of protection). Since the introduction of vaccines, diseases such as rubella have been eliminated from circulating in certain parts of the world. 11 http://www.niaid.nih.gov/topics/pages/com munityimmunity.aspx 12 2
Why continue to immunize? Just because the disease rates are low in the U.S. doesn t mean we won t be exposed. Given how our world now moves and travels, disease is only an airplane ride away! Example: Pertussis (whooping cough) in Japan, 1974-1981 Measles Mumps Rubella (MMR) Vaccine Provides protection against three viral illnesses. Recommended as a two-dose series, typically given at 12-15 months of age and 4-6 years. Two doses of MMR has been shown to be 98% effective against measles. Effectiveness against mumps is lowerestimated 88% (range 66-95%) 13 14 Mumps Mumps is a viral illness that causes parotitis (swelling of the salivary glands). Transmission is airborne or direct contact with droplet nuclei or saliva. Starts with nonspecific symptoms, such as headache, low-grade fever, malaise and muscle aches. Complications include orchitis, pancreatitis, deafness and rarely, death. 2015 Mumps Outbreak in Wisconsin There were 43 cases; all were laboratory confirmed by PCR. Affected eight counties and five university/college settings. Vast majority of cases were aged 18-25 years. Three individuals were hospitalized and two individuals developed orchitis. 15 16 2015 Mumps Outbreak in Wisconsin The majority of cases (64%) had previously received two doses of MMR vaccine. Why is this happening? 2015 Mumps Outbreak in Wisconsin To assess the effectiveness of the vaccine, one should compare the attack rate in those who are vaccinated with the rate in those who are not vaccinated. >2 Doses of MMR 29 (64%) 1 Dose of MMR 4 (9%) 0 Doses of MMR 4 (9%) Unknown/Under 8 (18%) Investigation 17 18 3
Outbreak Example Number of Individuals Number of Cases Attack Rate Percentage Vaccinated 950 29 3% 29/44= 66% Unvaccinated 50 15 30% 15/44= 34% Total 1000 44 2015 Mumps Outbreak in Wisconsin So while the absolute number of cases of mumps in individuals who are vaccinated is large, so is the number of exposed individuals who are vaccinated (and didn t get sick). From the 2006 U.S. outbreak, CDC has determined that while the majority of cases occurred in vaccinated individuals, the attack rate was much higher in unvaccinated individuals. 19 20 Are vaccines safe? ARE VACCINES SAFE? All vaccines used in the United States are required to go through extensive safety testing before they are licensed by FDA. Once in use, they are continually monitored for safety and effectiveness. Any vaccine can cause a side effect, but for the most part, these are minor (like a sore arm) and go away in a few days. Careful screening ensures that vaccines continue to be given in a safe manner. 21 22 Risk of Vaccination Serious reactions are extremely rare, and the risk of serious complications from a disease that could have been prevented is far greater. The choice to not be vaccinated is the choice to accept the risk of getting the disease, and transmitting that disease to others. Risk Comparison 139 Motor Vehicle Deaths Per 1,000,000 people 99 Unintentional poisonings Per 1,000,000 people Less than 1 serious allergic reaction to MMR vaccine Per 1,000,000 doses 1000 cases of encephalopathy after measles disease Per 1,000,000 cases 23 24 http://www.cdc.gov/nchs/fastats/accidental-injury.htm http://www.cdc.gov/vaccines/vac-gen/side-effects.htm#mmr 4
Recommended Vaccines for Children WHAT VACCINES ARE RECOMMENDED? Diphtheria Tetanus Pertussis (Whooping Cough) Polio Streptococcus pneumoniae Haemophilus influenzae Influenza Measles Mumps Rubella Varicella (Chickenpox) Hepatitis B Hepatitis A Meningococcal Human Papillomavirus 25 26 2016 Recommended Adult Immunization Schedule Adult Immunization Schedule Recommendation Groupings Recommended for all persons who: Meet the age requirement Lack documentation of vaccination, or Lack evidence of past infection Recommended for persons with a risk factor (medical, occupational, lifestyle, or other indication) No recommendation 27 http://www.cdc.gov/vaccines/schedules/hcp/adult.html 28 http://www.cdc.gov/vaccines/schedules/hcp/adult.html Vaccine Recommendations Based on Medical and Other Indications Wisconsin Immunization Registry (WIR) 29 http://www.cdc.gov/vaccines/schedules/hcp/adult.html Since 2000, collects immunization information for Wisconsin residents of all ages. Gathers information from vital records, public and private health care organizations, pharmacies, HMOs, Medicaid, WIC. As of February 2016, WIR contained 8,659,811 clients with 86,411,227 immunizations and had 5,508 active providers. 30 5
WIR Forecasting Functionality Your Immunization Record Wisconsin Immunization Registry (WIR) is a centralized repository of immunization information Located at https://www.dhswir.org/ To find your record, you will need to enter first name, last name, date of birth and social security number (or medical record number or Medicaid ID) Includes what immunizations you have had and what is recommended 31 32 33 34 Timing of Vaccination Timing of vaccination is critical. For example, to prevent head injuries from riding a bike, when is the best time to put on a bike helmet? A) Before you get on your bike B) When you are riding your bike C) After you have crashed COMMON MISCONCEPTIONS ABOUT VACCINES 35 Example courtesy of Dr. Jon Temte 36 6
Do vaccines cause autism? There is no link between vaccines and autism. A 2011 Institute of Medicine (IOM) report on 8 vaccines given to children and adults found that with rare exceptions, these vaccines are very safe. 2013 CDC study showed that vaccines do not cause Autism Spectrum Disorder (ASD). Numerous studies have also determined vaccine ingredients (such as thimerosal) 37 do not cause autism. Do children receive too many vaccines? From the moment babies are born, they are exposed to numerous bacteria and viruses on a daily basis. When they have a cold, they can be exposed to up to 50 antigens. A child who receives all the recommended vaccines may be exposed to up to 315 antigens by age two. This is not considered an appreciable burden on the immune system (1994 IOM report). 38 Can I get the flu from the flu vaccine? No, the flu vaccine cannot cause the flu. The vaccines either contain inactivated virus (influenza shot), or a weakened version (nasal spray) and cannot cause influenza. Side effects of the vaccine may occur, but are usually mild and self-limited. Should pregnant women be vaccinated? Yes! Women who are pregnant are at higher risk of complications from influenza and are recommended to receive influenza vaccine. Additionally, Tdap (tetanus, diphtheria and pertussis) vaccine is recommended during each pregnancy (ideally between 27-36 weeks gestation) to provide the newborn protection against pertussis. 39 40 Should pregnant women be vaccinated? Vaccination of mothers is important for the infant as they must rely on protection from the mother until they are old enough to be vaccinated. For influenza, an infant may be vaccinated starting at 6 months of age. Pertussis series begins at 2 months of age, with significant protection after 3 doses (approximately 6 months of age). Summary Vaccines have contributed tremendously to the health of our nation. Vaccines are a safe and effective way to prevent disease. High rates of vaccination are needed to keep ourselves and our communities healthy. 41 42 7
References Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/ The History of Vaccines, College of Physicians of Philadelphia http://www.historyofvaccines.org Institute of Medicine http://www.cdc.gov/vaccinesafety/researc h/iomreports/index.html Wisconsin Immunization Registry (WIR). Available at: https://www.dhfswir.org 43 8